MEDICARE: FLORIDA ORTHODONTIC INSTITUTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	11575	FL

General Provider Information

NPI Number	:	1992133995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA ORTHODONTIC INSTITUTE

Provider Business Mailing Address
First Line	:	5020 GUNN HWY
Second Line	:	#200
City	:	TAMPA
State	:	FL
Zip	:	33624-6379
Country	:	US
Telephone Number	:	813-264-7006
Fax Number	:	813-264-6072

Provider Business Practice Location Address
First Line	:	5020 GUNN HWY
Second Line	:	#200
City	:	TAMPA
State	:	FL
Zip	:	33624-6379
Country	:	US
Telephone Number	:	813-264-7006
Fax Number	:	813-264-6072

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	DR. LEO P. CHIN
Credential	:	D.M.D.
Telephone Number	:	813-264-7006

Provider Enumeration Date	:	10/29/2013
Last Update Date	:	10/29/2013

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Directions to “FLORIDA ORTHODONTIC INSTITUTE ” Practice Location

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